mpa tech role clinical services · 2016-09-02 · medication therapy management (mtm) ¡ medicare...
TRANSCRIPT
THE TECHNICIAN’S ROLE IN CLINICAL SERVICESNATALIE HOFFELMEYER
FRIDAY, SEPTEMBER 9, 2016
LEARNING OBJECTIVES
¡ Explain the importance of clinical services offered in the pharmacy
¡ Identify how technicians can assist the pharmacists in providing clinical services
¡ Describe how technicians can impact their patient’s health outcomes
DISCLOSURE:
¡ Natalie Hoffelmeyer does not have any potential conflicts of interest in relation to this presentation.
CLINICAL SERVICES
¡ Adherence Programs
¡ Medication Therapy Management
¡ Transitions of Care
¡ Specialty Programs
¡ Immunizations
ADHERENCE PROGRAMS
¡ Medication synchronization programs
¡ Medication synchronization
¡ Household synchronization
¡ Ordering out-of-stock medications in advance
¡ Contacting prescriber regarding prescription issues in advance
¡ Adherence assistance
ADHERENCE PROGRAM WORKFLOW
Technician: Enroll
Technician: Sync
medications
Technician: Review chart each month
Technician: Order
fulfillment
Pharmacist:Counsel
Technician: Sale
COMPREHENSIVE CHART
BENEFITS FROM ADHERENCE PROGRAMS
¡ Adherence
¡ Improve patient outcomes
¡ Inventory management
¡ Workflow
¡ Revenue
MEDICATION THERAPY MANAGEMENT (MTM)
¡ Medicare Prescription Drug, Improvement and Modernization Act of 2003 1
¡ MTM services are designed to promote enhanced patient understanding, increase patient adherence to medication regimens, and detection of adverse drug events and patterns of overuse and underuse of prescription medications 1.
¡ Medication Therapy Management (MTM) is medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients 1.
1 Medication Therapy Management (MTM) Services: Using MTM Platforms. Peggy Kuehl, PharmD, Stephanie Paul, PharmD
DRIVING FORCE FOR MTM: CMS STAR RATINGS
¡ Star ratings will be based on performance in several areas including:¡ Medication safety¡ Medication adherence¡ MTM completion rate
¡ Performance data will be analyzed for star ratings and reported to plans. ¡ Maintaining above-threshold performance data for the star rating will result in inclusion in
the Medicare preferred network.¡ Failure to do so will result in exclusion from the Medicare preferred network for a full
calendar year.
MEDICATION THERAPY MANAGEMENT (MTM)
¡ Includes a broad range of health care services such as:¡ Comprehensive medication reviews (CMR’s)¡ Targeted Intervention Programs (TIP’s)
¡ Adherence¡ Cost Effective Alternative¡ High Risk Medication ¡ Drug Interaction¡ Need Drug Therapy
MEDICATION THERAPY MANAGEMENT PLATFORMS
¡ 3 Most Common Platforms in Missouri:
¡ OutcomesMTM
¡ Medicare
¡ Mirixa Pro
¡ Medicare
¡ Direct Care Pro
¡ Missouri Medicaid
MEDICATION THERAPY MANAGEMENT PAYMENT
¡ OutcomesMTM and Mirixa Pro
¡ CMR’s range from $50 to $60
¡ TIP’s range from $10 to $20
¡ Direct Care Pro- paid based on time spent one intervention
¡ $10 - $20 for first 15 minutes (initial visit pays $20, every visit after that pays $10 for the first 15 minutes)
¡ $15 for each additional 15 minutes
2015 MTM STATISTICS- RED CROSS PHARMACY
¡ Total Completed Claims: 1661
¡ Average Revenue/Hour: $95.50*
CMR’s
Total claims: 390
Average Time: 25* minutes
Average Revenue: $52.00*
TIP’s
Total Claims: 610
Average Time: 10* minutes
Average Revenue: $11.00*
DCPro Interventions
Total Claims: 661
Average Time: 15* minutes
Average Revenue: $18.00*
* The numbers have been rounded
MTM PROCESS IN PLACE¡ EliteCare
¡ Creates predictable face to face encounter
¡ Allows more time for workup and documentation
¡ Managed centrally by Central Coordinator
¡ Pushes “TIPS”
¡ Manages Billing
¡ Alleviates burden on pharmacists
¡ Keeps process moving
MTM WORKFLOW
Central Coordinator: Check Platforms
Central Coordinator: Creates MTM Forms
for Encounters
Central Coordinator: Faxes/Emails MTM
Forms
Technician: Gather Data
Pharmacist:Reviews Encounter
Pharmacist:Completes Encounter
Technician: Scans Documents
Central Coordinator:*Bills & Tracks Encounters
ADHERENCE TIP
• List the last 3 refill dates• Is the medication being filled by CASH?• Has the patient received samples?• Has the dosage changed?• Has the medication been changed? • Is there another reason for non-
adherence?• Additional problems or concerns
THE TECHNICIAN’S ROLE IN MTM
¡ Check the platforms to find new MTM case to be completed
¡ Collect accurate information about the medications
¡ Preform appointment support functions
¡ Prepare medication adherence tools
¡ Provide educational reinforcement/support
¡ Complete billing and filing
¡ Conduct follow-ups with patients after reaching treatment goals
MTM OUTCOMES
¡ Centralizing MTM streamlines the process
¡ Less demand on pharmacists’ time
¡ Revenue
¡ Increasing Rx value
TRANSITIONS OF CARE (TOC)¡ The movement of a patient from one setting of care to another.¡ Impact of community pharmacist-led transitions of care services on rural hospital
readmission rates¡ Hospital readmissions cost the health care system $12-44billion annually 1.¡ The Affordable Care Act 2 implemented a new program aimed to improve this problem.
¡ Hospital Readmission Reduction Program
¡ Acute myocardial infraction (AMI)¡ Heart failure (HF)
¡ Pneumonia
¡ Chronic obstructive pulmonary disease (COPD)
¡ Elective total hip/knee arthroplasty (THA/TKA)
2 Center for Healthcare Research & Transformation (CHRT). Care Transitions: Best Practices and Evidence-based Programs. http://www.chrt.org/publication/care-transitions-best-practices-evidence-based-programs/. 3 Centers for Medicare & Medicaid Services [Internet]. Baltimore, MD. Centers for Medicare & Medicaid Services. 2012 [updated: 2014 Aug 4, cited: 2015 Aug 20]. Available from: https://www.cms.gov/Medicare/medicare-fee-for-service-payment/acuteinpatientPPS/readmissions-reduction-program.html
TOC- RED CROSS PHARMACY STUDY
¡ January 1, 2016- April 1, 2016¡ Subjects- patient self-identified Red Cross Pharmacy patients being discharged
from inpatient care at a local hospital with one of the follow conditions:¡ Acute myocardial infraction (AMI)¡ Heart failure (HF)¡ Pneumonia¡ Chronic obstructive pulmonary disease (COPD)¡ Elective total hip/knee arthroplasty (THA/TKA)
¡ Inclusion Criteria- ages 21 and over and self-identified RCP patient¡ Exclusion Criteria- patient discharged to end of life care¡ Levels of participation- full study or usual care
TOC PROCESS- STUDY
Follow-up phone call 30 days post-discharge
Follow-up phone call 7 days post-CMR
Pharmacist performs a CMR within 72 hours
Patient discharged from hospital
KEY PERSONNEL
¡ Central Coordinator- central contact between the pharmacy and the hospital
¡ Technician- responsible for scheduling all visits
¡ Pharmacists- Preform CMRs and follow up encounters
DRUG RELATED PROBLEMS
0
1
2
3
4
5
6
7
Types of DRPs Identified
Num
ber
of D
RP
s Nonadherence
Drug Indicated Not Prescribed
Inappropriate Drug Selection
Adverse Effect
Subtherapeutic Dosage
Supratherapeutic Dosage
Failure to Receive Drug
4 Impact of Community Pharmacist-Led Transitions of Care Services on Rural Hospital Readmission Rates: A Pilot Study. Allison Patton, PharmD PGY1 Community Practice Resident, UMKC/Red Cross Pharmacy, Inc.
PARTICIPANT COMMENTS
¡ Very impressed with amount of teamwork
¡ Did not have to repeat self
¡ Thorough communication
¡ Pleased with the amount of service provided
4 Impact of Community Pharmacist-Led Transitions of Care Services on Rural Hospital Readmission Rates: A Pilot Study. Allison Patton, PharmD PGY1 Community Practice Resident, UMKC/Red Cross Pharmacy, Inc.
OUTCOMES OF ALL TOC STUDIES
¡ Decreased 30 day readmission rate for patients with AMI, HF, pneumonia, COPD, and hip/knee replacement
¡ Improvement in understanding of medication use and indication
¡ Identified and addressed specific barriers that impacted adherence
¡ Patient satisfaction with RCP pharmacist involvement in TOC model
5 TrasitionalCare. Allison Patton, PharmD PGY1 Community Practice Resident, UMKC/Red Cross Pharmacy, Inc.
THE TECHNICIAN’S ROLE IN TOC
¡ Main contact for the hospital and PCP
¡ Gather and organize documentation for the patients
¡ Making appointments
SPECIALTY PROGRAMS
¡ Specialty pharmaceuticals are a recent designation of pharmaceuticals that are classified as high-cost, high-complexity and/or high touch
¡ Specialty pharmacy is defined as the service created to manage the handling and service requirements of specialty pharmaceuticals.
6 NBCH action brief. Specialty Pharmacy. nbch.org/nbch/files/ccLibraryFiles/Filenames/000000003258/NBCH_AB_SP Pharmacy original.pdf
SPECIALTY PROGRAM WORKFLOW
Central Coordinator: Monitors New &
Refill Scripts
Central Coordinator: Works with Specialty
Pharmacy Partner
Technician: Prepare Med for
Pharmacist Check
Pharmacist:Check Prescription
& Review Documentation
Technician:Notify Pt Medication
is Ready
Pharmacist:Counsel Pt & Completes
Documentation
Technician:Sell Rx
Technician:Scans and Reports
Documentation
BENEFITS OF THE SPECIALTY PROGRAMS
¡ Adherence
¡ Inventory management
¡ Workflow
¡ Revenue
IMMUNIZATIONS¡ Immunization Agreement- order and protocol for administration of vaccines
¡ Unless specifically noted otherwise, this standing order and protocol is for administration of:¡ Meningococcal vaccine
¡ Pneumococcal vaccine
¡ Herpes zoster vaccine¡ Viral influenza vaccine
¡ Hepatitis A vaccine
¡ Hepatitis B vaccine
¡ Diphtheria, tetanus, pertussis vaccine
¡ Epinephrine and/or Diphenhydramine in emergency situations
¡ For more details on Immunizations attend Christa Tetuan’s Immunization CE presentation
FLU SHOT WORKFLOW
Technician: Enroll
Technician: Sync
medications
Technician: Review chart each month
Technician: Order
fulfillment
Pharmacist:Counsel
Technician: Sale
CONCLUSION
Adherence Program
Medication Therapy
Management
Transition of Care
Specialty Care
Immunizations
THE TECHNICIAN’S ROLE IN CLINICAL SERVICES
Adh
eren
ce P
rogr
ams • Enrollment
• Med Syncing• Creating Pt Chart• Maintaining Pt
Calendar• Contacting Pt
monthly• Initiated Fill
Process
Med
icat
ion
The
rapy
Man
agem
ent • Check Platforms
• Collect Data• Schedule
Appointments• Notifying
Pharmacist• Prepare Med
Adherence Tools• Provide
Educational Support
• Complete Billing & Filing
• Conduct Follow-ups
Tran
sitio
n of
Car
e • Main Contact for Hospital & PCP
• Collect & Organize Documentation
• Schedule Appointments
• Notifying Pharmacist
Spec
ialty
Pro
gram
s • Monitor Script Activity
• Main Contact for Specialty Partner
• Gather Proper Documentation
• Notifying Pharmacist
• Filing
Imm
uniz
atio
ns
• Notifying Pts of Appropriate Vaccines
• Gather Proper Documentation
• Notifying Pharmacist
REFERENCES¡ 1 Medication Therapy Management (MTM) Services: Using MTM Platforms. Peggy Kuehl, PharmD, Stephanie Paul,
PharmD
¡ 2 Center for Healthcare Research & Transformation (CHRT). Care Transitions: Best Practices and Evidence-based Programs. http://www.chrt.org/publication/care-transitions-best-practices-evidence-based-programs/.
¡ 3 Centers for Medicare & Medicaid Services [Internet]. Baltimore, MD. Centers for Medicare & Medicaid Services. 2012 [updated: 2014 Aug 4, cited: 2015 Aug 20]. Available from: https://www.cms.gov/Medicare/medicare-fee-for-service-payment/acuteinpatientPPS/readmissions-reduction-program.html
¡ 4 Impact of Community Pharmacist-Led Transitions of Care Services on Rural Hospital Readmission Rates: A Pilot Study. Allison Patton, PharmD PGY1 Community Practice Resident, UMKC/Red Cross Pharmacy, Inc.
¡ 5 TrasitionalCare. Allison Patton, PharmD PGY1 Community Practice Resident, UMKC/Red Cross Pharmacy, Inc.
¡ 6 NBCH action brief. Specialty Pharmacy. nbch.org/nbch/files/ccLibraryFiles/Filenames/000000003258/NBCH_AB_SP Pharmacy original.pdf